20050464.pdf`11 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME�NAME OF BUSINESS
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NAME
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PERMITEXPIRES
PERMIT
NUMBER
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SUITE/APTH
PLAT NAME/SUBDIVISION NO.
LOT NO
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
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PRV REQUIRED
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ADDRESS
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NEW RESIDENTIAL PLUMBING ir MECH
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MIXED USE CHANGE OF USE
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REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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REMARKS
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GARAICW�ja RETAINING WALL FIRE SPRINKLER
CARPeR ROCKERY FIREALARM
(TYPE OF USEASINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CONSTRUCTION
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CODE
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OCCUPANT
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NUMBER
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NUMBER OF
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CONSULTANT
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DESCRIBE WORK TO BE DONE I
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GEOTECH REPORT
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEATSOURCE
LOT SLOPE%
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V . ESTED DATE
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Building Permit
City Surcharge
b� -
PLAN CHECK.NO:
Plumbing
-
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19,00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEE D TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
7
Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ,
IN VIOLATION 0 HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S Q01M�EfN?ATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy, and Fees are paid, and
receplykInowled%ed in space provided
OFFI (A SIO'NA UR
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=AT RAF WRR IG E N T):
DATE IGNED
--iiELEASEP) DATE
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 If IRC110. PINK -OWNER GOLD - ASSESSOR
110/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS